Robotic Versus Laparoscopic Partial Nephrectomy: A Prospective, Randomised Trial Comparing Two Surgical Techniques

Abstract

Purpose: To compare oncological, peri-, and postoperative outcomes of robot-assisted with those of laparoscopic partial nephrectomy. Patients and Methods: Thirty patients with low- or moderate-complexity renal tumors (R.E.N.A.L. nephrometry scoring) were randomized in a single-blind manner and operated on by the robot-assisted (n = 13) or laparoscopic (n = 17) approach. The primary outcome was oncological safety, based on the residual tumor (R) classification. Secondary outcome parameters were perioperative and postoperative results. The open-source R statistical software was used for statistical analysis. Results: Oncological outcomes did not differ significantly between the two surgical methods (p = 0.58). Operating time (p = 0.105), ischemia time (p = 0.884), overall length of hospital stay (p = 0.664), postoperative pain, and preoperative and in-hospital renal function scores were similar. Creatinine levels differed significantly six months postoperatively (robotic: 0.9 mg/dl versus laparoscopic: 1.1 mg/dl; p= 0.014). Intraoperative blood loss was significantly greater in the laparoscopic group (400 ml versus 168 ml; p = 0.028), which was also reflected in postoperative hemoglobin levels (13.8 mg/dl versus 12.5 mg/dl; p = 0.012). Peri- or postoperative complications did not differ significantly (p = 0.355). Subgroup analysis revealed significantly more frequent complications in patients with moderate-complexity tumors treated by laparoscopic surgery (p = 0.021). Conclusions: The oncological outcome in regard to the R status was similar in both groups. Intraoperative blood loss, postoperative renal function, and complications all benefited from robot-assisted surgery. Trial registration: The study was registered on ClinicalTrials.gov (NCT03900364; 03/04/2019).